Unprecedented scientific, medical, technological and even financial resources are available for human health in many parts of the world. Yet, we entered the new millennium with an unprecedented 30-fold gap between those who live and die marginalized from health services and opportunities for a dignified life, and those who count on health as their birthright. In this context, health equity looms among the biggest challenges facing twenty-first century societies.
The seminal 2004 study by the Joint Learning Initiative, followed by the 2006 World Health Report and more recently by the Global Health Workforce Alliance’s Scaling Up, Saving Lives point to human resources as key to solving this global crisis: getting enough of the right people in the right place doing the right things at the right time. Such champions of health equity allude to the kind of physician needed within a broader strategy to train and retain a global health workforce capable of guaranteeing basic health care to everyone. They are joined by value-driven medical education reformers who advocate return to a more service-oriented ethic for medicine. Together, the two streams are producing a powerful current, as socially responsive medical education joins the broader drive for socially equitable health policy.
Yet, there is much work to be done to muster the political will needed to change the course of an entire profession and medical training with it.
The China earthquake, 2008. New Orleans’ Hurricane Katrina, 2005. The Indonesian tsunami, 2004. These are the Big Ones that startle the front pages and bring disaster home. But the lasting story lies behind the headlines where vulnerabilities are laid bare, and between the disasters themselves, where the opportunity for mitigation begins.
The iceberg once seemed the perfect image to represent the global dilemma of vascular diseases: the apex of heart disease, stroke and chronic kidney disease was visible over the horizon’s edge, with the bloated and often under-diagnosed epidemics of hypertension, diabetes mellitus, and common risk factors lurking in the depths below. The iceberg also floated in colder waters, a handy metaphor for the chronic disease pattern that was sweeping across the industrialized north.
For years, the Internet has been the new black, the “in” thing, the must have. And the virtual fever is spreading. According to the World Bank, global Internet use more than quadrupled between 2000 and 2005, from 15 users per 1000 population to 67.[1] Yet, many Global South countries are stalled on the Information Superhighway: the same World Bank report found that only 15 per 1000 population in sub-Saharan Africa are connected to the Internet, and only 21 per1000 in South Asia. To say nothing of glaring access inequalities within countries, lack of foreign investment in the communications sector of developing nations, and deficient connectivity in key areas of national infrastructure – schools, government centers, and health facilities. Yet the same World Bank report noted that eHealth initiatives ranked last in a list of technology strategies among countries surveyed.[1]
The information gap between rich and poor countries is widening, and the digital divide is more dramatic than any inequity in health or income.[1] Of 3.47 million articles in 4,091 health-related publications reviewed from 1991 to 2002, 90% were contributed by authors in the 20 most developed nations; writers from the 63 poorest countries accounted for under 2%. Representation from sub-Saharan Africa actually declined over the period, and 96% of the articles were in English. A 2003 survey found only two of 111 editorial board members in a selection of leading medical journals came from low-income countries.[2,3,4]
